You want to start by finding out if he is being bullied or just misreading cues

My 10 year old son struggles with anxiety and has trouble fitting in socially. He is gifted and sensitive and has low self-esteem. Because of this, he often tries too hard with his peers, which ends up back firing. He took up soccer to fit in better, but it isn't helping because he is behind their skill level and they give him a hard time. I've witnessed the kids being very mean to him, and I wonder if he is doing things to turn them off.

He is taking medication for anxiety and ADHD and sees a therapist. He picks at his skin constantly and has recently started pulled hairs off his legs, arms, and eyebrows. His dad and I have divorced and I've remarried, but my son seems to be dealing with that well. My ex and I have a great relationship, and my son loves being around his new step sister and brother.

Thanks so much for reaching out. It sounds like you have several different questions, and I’ll do my best to answer them.

First of all, while divorce can cause stress for a child, in my clinical experience, it’s the conflict (eg arguing, fighting) that surrounds a divorce that causes more harm than the divorce itself . It’s a good thing that you and your ex have a great relationship, because having open lines of communication is really key, especially for families with a child who is struggling.

For any child, especially children who are only children first, integrating into a new family is always a challenge. The best thing you can do to help is try to offer as much consistency as possible. This includes communicating with your ex so there are consistent rules and expectations in both households, and continuing to let your son know that he is an important part of the family.

In terms of your son’s social issues, it would be really helpful if you could get some objective information from the teachers, a school psychologist, or other people who have the chance to observe him in the context of other kids. If there is a bullying situation going on, you want to address that right away. If it’s more of an issue of him misperceiving some social scenarios, or needing to develop his social skills, those are things he can work on in therapy.

You say that your son has been picking at his skin (which could indicate that he has excoriation disorder) and has recently been pulling hair (which could be trichotillomania). It is important to give your therapist a sense of how long these things have been going on and how severe they are.

There are excellent treatments for these disorders, including habit-reversal therapy. However, not all therapists have experience with this type of treatment, so it is completely reasonable to ask your therapist if this is something he or she has experience with, and to consider looking for someone else, if necessary. For anxiety in general, cognitive behavioral therapy is the treatment of choice, even for kids who are only 10 years old.

Finally, it isn’t surprising that when kids are struggling with anxiety and/or ADHD it can impact their self-esteem and confidence, even if they’re bright. Try to keep in close contact with his therapist and pay attention to his overall mood, sleep, and appetite, because he could be at risk for depression. And since he is taking medication, I would recommend that you continue to have ongoing consultations with the prescribing psychiatrist to make any changes that might be needed.

Make sure to communicate what you have been noticing, highlighting any changes in his mood or behavior, so the psychiatrist knows exactly what you observe. Finally, if your next appointment with the psychiatrist is not for a while, considering making an appointment sooner, so you can share your current concerns.

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